| NPI | 1043286990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: SC 34770) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A069266) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2012-07-05 |